Self-Care Strategies

Dietary Modifications

The consumption of acidic foods and drinks, such as citrus fruits and juices, pickled foods, wine, ciders, fruit yogurt, and carbonated beverages should be controlled, since they can contribute to erosion of the enamel or cementum and expose underlying dentin.52 Brushing immediately after ingesting acidic foods should also be avoided as it may accelerate the combined effects of abrasion and erosion.47-49 Additionally, acidic food and drink, especially fruits and fruit drinks, dissolve the smear layer in a few minutes.52 Erosion also causes dissolution of the smear layer increasing the patency of the tubules.31 Extreme dentin loss from combined erosive and abrasive behaviors as seen in purging and acid reflux has been demonstrated.48 In managing hypersensitivity, brushing before eating acid containing or generating foods is recommended, although this is counter to recommendations for caries prevention. Additional recommendations can include sipping acidic beverages through a straw, reducing the quantity and frequency of acid intake, drinking something neutral or alkaline—such as milk or water—after consuming dietary acids, and avoiding foods that have sharp flavors, spices, or are extremely hot or cold. An approach as simple as making dietary changes could provide pain relief. Having the client complete a diet history might reveal a daily acidic exposure such as a morning glass of grapefruit juice that could precipitate an entire day of hypersensitivity. If the client reports brushing after drinking the juice, the condition could be exacerbated by the combination of acid erosion setting the stage for abrasion. Also, the possibility of eating disorders that include purging behaviors should not be overlooked. Appropriate treatment and referral of such clients is essential.